This invention relates in general to techniques and apparatus for passing a silastic tube or vascular graft through a living body subcutaneously, more particularly when performing a peritoneovenous shunt or an arterial bypass.
Such techniques are used primarily for the diversion into the venous system of ascitic fluid, which collects in the peritoneal cavity from the liver capillaries during certain conditions associated with cirrosis of the liver or ascites that developes secondary to abdominal malignancy. The accumulation of excessive fluid in the peritoneal cavity causes increased intra-abdominal pressure which may restrict the respiratory function, and also causes severe protein and caloric malnutrition which interferes with the appetite, and depletes the nutritional state of the body, lowering the resistance to infection and possibly causing peritonitis. Such techniques are also used for the placement of vascular graft between two patent areas of the arterial system to bypass an occluded area of an artery such as a femoropopliteal bypass from the common femoral artery to the popliteal artery to bypass an occluded superficial femoral artery.
In order to relieve the accumulation of excessive ascitic fluid in the peritoneal cavity and the pathophysiological changes which it brings about, and to partially compensate for the severe protein and caloric malnutrition which accompanies such accumulations, techniques have been devised in the prior art for diverting the ascitic fluid into the venous system. These are described in detail in a paper entitled Peritoneovenous Shunting for Ascites by Harry H. LeVeen, M.D., George Christoudias, M.D., Moon IP, M.D., Richard Luft, M.D., Gerald Falk, M.S., Saul Grosberg, M.D., Annals of Surgery, October 1974, Vol. 180, No. 4, Pages 580-591, Copyright by J. B. Lippincott Co., 1974, and a booklet entitled Current Problems in Surgery, Vol. XVI, No. 2, February 1979, Ascites: Its Correction by Peritoneovenous Shunting, by Harry H. LeVeen, M.D., Simon Wapnick, M.D., Carlos Diaz, M.D., Saul Grosberg, M.D, and Michael Kinney, M.D., published by Year Book Medical Publishers, Inc., Chicago, Ill., .COPYRGT. Copyright 1979.
The techniques for a peritoneovenous shunt there described involve the passage subcutaneously from an abdominal incision to an incision in the neck of a slender bronchial alligator or rectal biopsy forceps. A long line of suture is attached to the forceps and pulled from the neck incision to the abdominal incision with the withdrawal of the forceps from the tunnel. The suture is then tied to the silastic tubing which is pulled cephaled by gentle traction until it is delivered to the neck.
There are a number of disadvantages to this technique. More trauma is caused to the patient by repeated passage through the subcutaneous tunnel between the incisions in the abdomen and neck. Further, there is always a chance that the suture or the slender forceps may break while making the subcutaneous tunnel. Furthermore, a substantial amount of time is required for delivery by this rior art technique of the silastic tube from an incision in the abdomen to an incision in the neck, which time delay may be an important factor due to the poor condition of the patients undergoing this procedure.